Report of the first meeting of the

Strategic and Technical

Advisory Group for
Noncommunicable Diseases:
virtual meeting, 27–28 October 2021
Report of the first meeting of the

Strategic and Technical

Advisory Group for
Noncommunicable Diseases:
virtual meeting, 27–28 October 2021
Report of the first meeting of the Strategic and Technical Advisory Group for Noncommunicable Diseases:
virtual meeting, 27–28 October 2021

ISBN 978-92-4-004115-8 (electronic version)

ISBN 978-92-4-004116-5 (print version)

© World Health Organization 2021

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-
ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial
purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should
be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO
logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent
Creative Commons licence. If you create a translation of this work, you should add the following disclaimer
along with the suggested citation: “This translation was not created by the World Health Organization
(WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition
shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the
mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/
rules/).

Suggested citation. Report of the first meeting of the Strategic and Technical Advisory Group for
Noncommunicable Diseases: virtual meeting, 27–28 October 2021. Geneva: World Health Organization;
2021. Licence: CC BY-NC-SA 3.0 IGO.

Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit
requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as
tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse
and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any
third-party-owned component in the work rests solely with the user.

General disclaimers. The designations employed and the presentation of the material in this publication
do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status
of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or
boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not
yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are
endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned.
Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication.
However, the published material is being distributed without warranty of any kind, either expressed or
implied. The responsibility for the interpretation and use of the material lies with the reader. In no event
shall WHO be liable for damages arising from its use.

This publication contains the report of the Strategic and Technical Advisory Group for Noncommunicable
Diseases and does not necessarily represent the decisions or policies of WHO.
Contents

Acronyms and abbreviations iv

Introduction 1
Summary recommendations 3
Opening session 5
Session 1: Members’ areas of expertise 8
Session 2: Scaling up cost-effective interventions to address risk factors 9
Session 3: What is required of STAG-NCD 12
Session 4: Improving diagnosis and treatment,
monitoring and surveillance 14
Session 5: Health diplomacy 17
Closing session 19
References 22
Annex 1: Agenda for STAG-NCD first meeting 23
Annex 2: List of participants 25
Annex 3: Background paper to first meeting of the STAG-NCD group 27
Annex references 39
 Acronyms and abbreviations

CARICOM Caribbean Community

HLM high-level meeting
FCTC Framework Convention on Tobacco Control
FENSA Framework for Engagement with Non-State Actors
LMICs low- and middle-income countries
MPTF Multi-Partner Trust Fund
NCD noncommunicable disease
NCD-GAP Global action plan for the prevention and control of
noncommunicable diseases
ODA overseas development assistance
OECD Organisation of Economic Co-operation and Development
PHC primary health care
SDG Sustainable Development Goal
STAG-NCD Strategic and Technical Advisory Group on the Prevention and
Control of Noncommunicable Diseases
UHC universal health coverage
UN United Nations
UNESCO United Nations Educational, Scientific and Cultural Organization
UNGA United Nations General Assembly
WHA World Health Assembly
WHO World Health Organization

iv
Introduction
The World Health Organization (WHO), through its global
programme on noncommunicable diseases (NCDs), leads and
guides the global effort on surveillance, prevention and control of
NCDs to reduce the avoidable burden of morbidity, mortality and
disability due to noncommunicable diseases (NCDs).

Its major functions include:

• providing global leadership to reduce the avoidable burden of morbidity,

mortality and disability through strategy development, political and
multisectoral engagement, strengthening accountability, advocacy and
partnerships, including with civil society;

• developing policy options, norms and standards of NCD prevention and care;

• facilitating universal access to people-centred prevention and care;

• shaping the NCD research and innovation agenda and stimulating the
generation, translation and dissemination of knowledge;

• working with WHO regional and country offices, providing technical support
for Member States and partners, to catalyse change and build sustainable
capacity; and

• monitoring, evaluating and reporting on the status of the NCD epidemic and
progress in attaining the voluntary global NCD targets and the Sustainable
Development Goal (SDG) target 3.4 on NCDs.

Mission and functions of STAG-NCD

The Strategic and Technical Advisory Group on the Prevention
and Control of Noncommunicable Diseases (STAG-NCD) acts as an
advisory body to WHO to further its efforts and work in addressing
the prevention and control of NCDs.

The aim is to strengthen international and national action to: reduce premature
mortality from NCDs through prevention and treatment; progressively cover
additional people with health services, medicines, vaccines, diagnostic and health
technologies; and strengthen efforts to address NCDs as part of Universal Health
Coverage (UHC).

In its capacity as an advisory body to WHO, the STAG-NCD has the following
functions:

1. To identify and describe current and future challenges;

2. To advise WHO on strategic directions to be prioritized;

3. To advise WHO on the development of global strategic documents; and

4. To propose other strategic interventions and activities for implementation by

WHO.

The Terms of Reference for STAG-NCD are provided here.

The first meeting of the STAG-NCD took place virtually from 27–28 October
2021 (see agenda in Annex 1). The meeting was organized by the WHO NCD

1
 Programme, which provides the Secretariat for the advisory body. For 2021–2022,
there are 24 members of STAG-NCD. Twenty-two members were in attendance
for the first meeting. The STAG-NCD members were joined by staff from WHO
headquarters and representatives from its six Regional Offices (see list of
participants in Annex 2).

A background paper summarizing the key milestones in the development of the

global public health agenda for addressing NCDs over the last two decades was
circulated among all STAG-NCD members (Annex 3). The purpose of the document
was to provide the necessary background information and key questions to guide
the discussions of the first meeting of STAG-NCD. The agenda for the meeting and
the list of participants are in Annex 2 and Annex 3, respectively.

This report provides a summary of the first meeting of STAG-NCD, with a focus on
the strategic discussions and recommendations of STAG-NCD to WHO for the topics
addressed.

The consolidated report was reviewed by the STAG-NCD Chair and by STAG-NCD
members. An outcome document containing the recommendations of this report
is submitted by the Chair of the STAG-NCD and the Director of the WHO NCD
Programme to the Director-General of WHO.

Objectives of the first meeting of STAG-NCD

At this first meeting, WHO requested STAG-NCD to review and advise on a number
of areas of WHO NCD work. The WHO STAG-NCD Secretariat and the Chair of
STAG developed the agenda for the first meeting based on the priorities of WHO’s
NCD work in 2021–2022, notably on the recommendations outlined in the Mid-
point evaluation of the implementation of the WHO global action plan for the
prevention and control of NCDs 2013–2030 (1).

The agenda items are summarized below:

Day 1

• Introduction and welcome remarks;

• Setting the scene, scope and purpose;

• Introduction, vision and contribution of STAG-NCD members;

• Focusing the limited financial resources available for NCDs and raising resources
for scale-up of the most cost-effective options, considering the impact of
COVID-19; and

• Exploring why progress in addressing tobacco use has not yet been seen in
relation to other risk factors: physical inactivity, unhealthy diet and harmful use
of alcohol.

Day 2

• What is the “ask” of NCD directors in WHO headquarters and the regions from
STAG-NCD?

• Ensuring that those affected by NCDs are diagnosed and treated to improve
health outcomes, using very cost effective and sustainable approaches;

• Strengthening monitoring and surveillance of NCD responses;

• Exercising the leadership and coordination role of WHO in the preparatory

process towards the fourth High-level Meeting (HLM) of the United Nations
General Assembly (UNGA) on the Prevention and Control of NCDs in 2025.

2
Summary recommendations

Scaling up cost-effective interventions to address

risk factors
STAG-NCD recommends that WHO should:
Technical support

1. Provide technical support and mentorship to help countries build

political commitment and accelerate their response to NCDs.

2. Provide countries with technical guidance on undertaking costing

exercises, on incorporating NCD funding needs into budget plans, and
to ensuring sustainability of NCD programmes.

3. Provide further technical guidance to countries to strengthen health

information systems.
Monitoring

4. Guide and support countries to strengthen accountability and

transparency.

5. Encourage countries and donors to introduce shadow reporting

from civil society to verify the implementation of NCD policies and
interventions.
Policy development

6. Support countries to document their best practices and pathways

to policy success, and to analyse their political, economic, social
landscape, so that they can better tailor their policies and
interventions.

7. Further support countries to develop sustainable health financing

mechanisms and to integrate NCDs into universal health care (UHC)
packages, thereby safeguarding equity and sustainability.

8. Support countries to produce fact sheets and other communication

tools, devise tax policies for sugar, salt and trans fats, and develop
national investment cases for addressing NCDs.
Access to health care

9. Provide further technical support to improve access to quality

medicines, diagnostics and devices, including support to strengthen
national regulatory authorities, treatment optimization, and
technologies to increase purchasing power and improve affordability.

10. Continue to provide technical support for sustainable, cost-effective

and integrated primary and secondary health care programmes,
using treatment of diabetes, hypertension, tobacco use and other risk
factors as entry points.

3
 Improving diagnosis and treatment, monitoring
and surveillance
STAG-NCD recommends that WHO should:
Diagnosis and treatment

11. Continue to provide technical guidance for early detection and

treatment of diabetes, hypertension and other comorbidities through
an integrated primary health care approach.

12. Further support countries to empower people to take an enlightened

interest in self-care by actively promoting health literacy.
Health care provision

13. Provide further technical support to countries to prioritize cost-

effective, high-impact NCD interventions as core essential components
of a UHC basic benefits package.

14. Continue to enhance countries’ capacity to address NCDs through

strengthening of workforce capabilities in ministries of health,
and through the institutionalization of protocol-based training of
grassroot health care workers in NCD management and COVID-19
recovery.
“Best buy” options

15. Continue to develop and support the uptake of simple operational

guidance for implementing best buys for countries and other
partners.

16. Provide technical support to government ministries and civil society

organizations to work as one to finance and scale-up NCD best
buys, protecting these initiatives from interference from commercial
entities with conflicting interests.
Monitoring and surveillance

17. Continue to support countries to effectively engage people living

with NCDs, embracing their involvement across governance, policy
development, service design and delivery, and monitoring and
evaluation, taking into account conflicts of interest.

18. Continue to support countries to develop responsive and robust

information systems for surveillance and monitoring of progress of
NCD prevention and control.

4
Opening session
At the commencement of the opening session, Dr Bente Mikkelsen, Director, WHO
Global NCD Programme, presented the Declaration of Interests of the STAG-NCD
members. Eight members had declared interests which were considered potentially
significant but unlikely to affect the expert judgment on the issues under
consideration in the First Meeting of STAG-NCD.

Professor Veronika Skvortsova, Former Minister of Health, Russian Federation, was

nominated and confirmed as Chair of STAG-NCD. She presented the provisional
agenda of the meeting which was adopted.

Dr Jennifer Cohn was nominated as co-Chair and confirmed. Dr Andre Pascal and
Dr Khaleda Islam were nominated as Rapporteurs and confirmed.

Professor Skvortsova welcomed all participants and highlighted the need to focus
discussions and recommendations of STAG-NCD on the key NCD issues outlined in
the agenda and on building back better in the context of the COVID-19 pandemic.
In her opening remarks, she recalled that the first Global Ministerial Conference
on Healthy Lifestyles and NCDs was organized jointly in Moscow in April 2011 by
the World Health Organization and the Government of the Russian Federation.
The “Moscow Declaration”(2), the outcome of the conference, acknowledges the
impact of NCDs on health and socio-economic development and the existence
of significant inequities in the burden of NCDs and in access to prevention and
control. These are ongoing challenges of NCDs which can only be tackled through
whole-of-society and whole-of-government approaches and by UHC. She stressed
that WHO should be at the centre of civil society action for NCD prevention and
control. She also emphasized the need for sustainable financial mechanisms to
support NCD prevention and control, particularly in low- and middle-income
countries (LMICs). In this regard, the United Nations (UN) Multi-Partner Trust Fund
(MPTF) is a significant new partnership initiative convened by the United Nations
Inter-Agency Task Force on the Prevention and Control of NCDs, to catalyse
stronger responses to NCDs and mental health at country level.

On behalf of the WHO Director-General, Dr Ren Minghui, Assistant Director-

General, Universal Health Coverage/Communicable and Noncommunicable
Diseases and Dr Naoko Yamamoto, Assistant Director-General for Healthier
Populations, delivered the opening addresses.

Dr Ren Minghui thanked the STAG-NCD members for agreeing to serve on the
STAG-NCD and welcomed all participants to the first meeting. He stated that the
establishment of STAG-NCD by WHO was a reflection of the need to discuss and
debate pathways for all countries to better address NCDs during the COVID-19
pandemic and during the recovery phase. He requested that STAG-NCD assist WHO
to seize this moment of crisis to transform the NCD agenda and move NCDs from
the periphery of public health discussions to centre stage, where they belong. He
said that the UN General Assembly Resolution 75/130 (3) was a strong signal of
intent to bolster resilience to future shocks. The resolution noted with concern
that people living with NCDs are more susceptible to the risk of developing
severe COVID-19 symptoms and are among those most affected by the pandemic;
it recognized that necessary efforts for the prevention and control of NCDs are
hampered by a lack of universal access to essential health services, medicines,
diagnostics and health technologies for NCDs. He informed STAG-NCD that the
World Health Assembly (WHA) has asked the WHO Secretariat for support through
development of an “Implementation roadmap 2023–2030 for the global action

5
 plan for the prevention and control of NCDs 2013–2030” (4) and that the roadmap
will provide a basis for countries to decide on pathways to accelerate progress
towards achievement of SDG target 3.4 in the next 10 years. The road map will
go hand-in-hand with an updated set of best buys and other recommended
interventions for the prevention of NCDs, and a new web-based simulation
tool to support countries in selecting a prioritized set of NCD interventions. The
implementation roadmap, the best buys and the simulation tool will be completed
in 2022 and will be presented to the WHA in 2023. He invited STAG-NCD to seize
this opportunity to help WHO to turn the clock forward on the rights of 1.7 billion
people living with NCDs around the world, and give them the opportunity to
attain the health-for-all we all seek.

Dr Naoko Yamamoto, in her opening remarks, stressed the critical importance

of implementing health promotion and population-wide prevention strategies
to address the root causes of the NCD epidemic, including through whole-of-
society and whole-of government approaches. A life-course approach to NCD
prevention that addresses behavioural and environmental risk factors as well as
social determinants of health has the undeniable potential to halve the global
NCD burden. The challenges of rising costs of medical care, widening inequalities
and the impact of ageing populations on the NCD burden call for acceleration of
UHC and more effective transformation of scientific evidence to concrete action to
tackle NCDs at global, regional and national levels. She asked the STAG-NCD for
their strategic advice and guidance in making this transformation a reality.

Dr Bente Mikkelsen set the scene for the meeting by providing the background,
scope and objectives. She pointed out that in 2019, NCDs accounted for 74% of
global deaths and that seven out of the 10 leading causes of death were NCDs.
While mortality trends for communicable diseases and perinatal conditions are
declining, NCD mortality continues to rise. Over the last ten years, an average of
15.2 million people a year between the ages of 30 and 70 years have died from
NCDs; 12.9 million of them were from LMICs. The rate of progress in reducing
premature mortality has slowed since 2010, but inequities in relation to NCDs have
widened. For example, the combined population of 30 LMICs (1 billion people)
have a three-fold greater risk of dying from an NCD compared to the population
of 45 high-income countries (HICs) (range 8%–14% vs 25%–31%).

She stated that despite high-level commitments, the progress in NCD prevention
and control has not been adequate. For example:

• only 6% of WHO Member States (n=14) were on track to achieve SDG target
3.4 (a 30% reduction in premature mortality from NCDs by 2030 against a 2015
baseline);

• only 34 countries have implemented 10 or more of the commitments made on

NCDs at the UN General Assembly, while 66 have implemented fewer than five,
including four that have implemented none;

• No countries are on track to achieve all nine voluntary global targets for 2025,
set by the WHA in 2013 against a baseline in 2010; and

• the WHO Global Monitoring Report for UHC in 2019 shows rapid improvements
in coverage of communicable disease, but shows relatively little change in NCD
services and capacities since 2000, particularly in low-income countries.

Although 136 countries have reported that NCD services have been disrupted
during the COVID-19 pandemic, only 107 have included NCDs in national COVID-19
recovery plans.

6
The implementation roadmap 2023–2030 for the NCD-GAP is to ensure the
following:

• alignment with the 2030 Agenda and other internationally agreed NCD targets;

• that the health-care needs of the rapidly growing 30–70 years population
group are addressed;

• identification of options for achieving NCD targets;

• resilience of health systems to treat people with NCDs during complex

emergencies;

• that recommendations from the mid-point evaluation lead to corrective

actions; and

• the use of COVID-19 as a new lens through which to view NCDs when building
back better.

She drew the attention of the STAG-NCD to the 12 recommendations of the

Mid-point evaluation of the NCD-GAP 2013–2020 (5) (see Table A3, Annex 3), and
explained the three strategic directions of the implementation roadmap that will
be submitted to the Executive Board and the WHA in 2022.

1. Accelerate national response based on the understanding of the epidemiology

and risk factors of NCDs and the identified barriers and enablers in countries.

2. Prioritize and scale-up the implementation of most impactful and feasible

interventions in the national context.

3. Ensure timely, reliable and sustained national data on NCD risk factors, diseases
and mortality for data-driven actions and to strengthen accountability.

In order to accelerate NCD prevention and control at country level, WHO is in the
process of further updating Appendix 3 of the NCD-GAP, which contains best buys
and other recommended interventions for NCDs. Finally, Dr Mikkelsen highlighted
the escalating demand from countries for technical support for NCD prevention
and control and the dire need to strengthen the capacity of WHO at all levels to
respond to these demands.

Dr Ruediger Krech, Director Health Promotion, spoke about the fundamental

need to complement NCD management efforts with multilevel and multifaceted
interventions to tackle the underlying root causes of NCDs. These multilevel
interventions address the main NCD risk factors: tobacco use, harmful use of
alcohol, unhealthy diet and physical inactivity. To facilitate their implementation,
WHO has developed technical packages and tools (“signature solutions”) such
as MPOWER, which addresses all aspects of tobacco control. He reiterated the
need to increase levels of physical activity by changing social norms and attitudes
to create active societies and active people, providing opportunities to create
active environments through green spaces and creating active systems through
governance and policy. He informed STAG-NCD that WHO has established separate
strategic advisory groups to strengthen the work related to behavioural risk
factors of NCDs, health promotion, well-being and social determinants of health,
and mental health and substance abuse.

7
 Session 1: Members’ areas of expertise
Session 1 was chaired by Professor Veronika Skvortsova and supported by Dr
Cherian Varghese, Cross-cutting Lead NCD and Special Initiatives. STAG-NCD
members briefly presented their vision of WHO’s NCD prevention and control
programme and their planned contribution to the STAG-NCD. They expressed
interest in contributing to the NCD agenda based on a wide range of expertise and
experience including:

• surveillance and monitoring

• improving accuracy of data

• population prevention

• health promotion

• primary health care (PHC) approaches

• public health approaches

• health governance

• multisectoral action

• promoting health equity

• patient perspectives

• health system research

• implementation research

• policy development and implementation

• policy analysis

• stroke prevention, care and rehabilitation

• models of stroke care for low-resource settings

• NCD care in hospital

• cancer registries

• communicable diseases

• working with civil society networks

• promoting accountability

• combatting industry interference

• addressing commercial determinants of health

• convening public–private partnerships to advance the NCD agenda

• forging south–south collaboration.

8
Session 2: Scaling up cost-effective
interventions to address risk factors
Session 2 was chaired by Dr Jennifer Cohn and supported by Dr Ruediger Krech.

Key questions
WHO needs to better adapt its NCD programme to the range of country contexts
in which it works, in the COVID-19 pandemic and post-COVID-19 period.

Taking NCD-GAP mid-point evaluation recommendations 2 and 3 (see Table A3,

Annex 3) as the starting point, and framing them through the settings of low-,
lower-middle, upper-middle and high-income countries, the meeting considered
the following questions:

• How can Member States focus the limited financial resources available for NCDs
on the most cost-effective NCD interventions, and how can they raise resources
for scale-up, considering the impact of COVID-19?

• Mindful of the impacts seen in tobacco control, what measures can Member
States adopt to address other NCD risk factors: harmful use of alcohol,
unhealthy diet, and physical inactivity?

STAG-NCD:
WELCOMES and applauds WHO’s leadership since the beginning of the COVID-19
pandemic to control the pandemic while continuing to accelerate global efforts
to tackle NCDs despite the impact of the pandemic.

NOTES the interplay between COVID-19 and NCDs that is directly and indirectly
causing morbidity and mortality in four ways:

• due to people living with NCDs being more susceptible to the risk of developing
severe COVID-19 and suffering worse outcomes;

• due to the inability of health systems to provide ongoing essential health

services, for the prevention, early diagnosis and treatment of NCDs during the
COVID-19 pandemic;

• due to the socioeconomic impact of the interplay between the COVID-19

pandemic and NCD epidemic which is affecting people in their most productive
years;

• due to increased digital marketing of unhealthy products during lockdown/stay

at home orders.

NOTES that COVID-19 services and public health campaigns could be used for
opportunistic screening of NCDs and for imparting health education to people
on tobacco cessation, physical activity, healthy diet and avoiding harmful use
of alcohol, all of which can also help to build up immunity against infections,
while also preventing NCDs. Learning from the lessons of COVID-19 that
the role of patient and community participation in NCD prevention and
control could be further strengthened and that help-lines, and mobile and
telemedicine technologies can be further developed to strengthen NCD
management.

9
 ACKNOWLEDGES:

• That transnational corporations and commercial determinants of NCDs are

closely linked, making it unrealistic to expect that high-income countries, where
transnational corporations are headquartered, would act against their national
interests to finance NCD prevention in LMIC;

• The need to provide intellectual capital to strengthen the policy backbone of

Ministries of Health in LMIC, enabling them to develop and implement policies
for taxation of tobacco, alcohol and unhealthy food and other cost-effective
policies;

• The need to tap into reasons beyond health to convince decision-makers of the
importance of policies that support healthy behaviour, for example the need to
implement alcohol control policies to safeguard the efficiency of the workforce
and the resulting impact on the economy; and

• That Small Island Developing states (SIDs) are in a special category in the NCD
policy dialogue, based on their distinct vulnerabilities to climate change, food
insecurity and other impacts.

RECOGNIZES the need to:

• Engage and resource the civil society and communities more widely to harness
their potential contribution to support NCD prevention and control efforts;

• Focus not only on policy development but also on tracking policy

implementation and policy outcomes at country level;

• Better understand how to motivate behaviour change including through

anthropological and behavioural science research; and

• Shift resources and provide on-line training resources to empower grassroots-

level health workers and communities to harness their contribution to address
NCDs.

EMPHASIZES that WHO needs to provide technical support to countries to:

• Enable patient groups to contribute to health education, self-care, screening

and social mobilization as appropriate;

• Improve and monitor quality of in-patient NCD care;

• Strengthen multisectoral collaboration through mapping of the stakeholder

landscape and identification of barriers and enablers; and

• Help build a political enabling regulatory and legislative environment, and good
governance and transparency as a way of combatting industry interference.

RECOGNIZES the need to build evidence on implementation of best buys and build
policy relevant research prioritizations to help guide donors and researchers.

RECOGNIZES WHO’s convening power to enable and influence relevant

stakeholders, excluding those with conflicting interests to enhance their impact
on accelerating NCD prevention and control, at national, regional and global
levels.

STAG-NCD also notes that the difference between what has happened in the
control of tobacco and other risk factors is in large part because of the courage
of the intergovernmental agencies to promote the Framework Convention
on Tobacco Control (FCTC), particularly Article 5.3, which deals with the issue
of how governments protect policies from industry interference. The FCTC
facilitated injection of resources, generation of evidence on tobacco control

10
interventions and policies, and the development of process and outcome indicators
for monitoring tobacco control. FCTC and evidence of the harmful effects of
secondhand smoke have also helped the denormalization of the tobacco industry.

The alcohol industry relies on very heavy use of alcohol for a significant part of
its sales and profits. Thus, it interferes with effective policies that would have the
effect of reducing its profits. There are real issues that WHO needs to address in
terms of the relationship with the industry now, and the extent to which WHO can
play a role in normative influence across the UN system. Within its own processes,
it should look very carefully at interactions such as the current dialogues with the
alcohol industry; for example, it should be asking questions about how closely
aligned the dialogues are with the Framework for Engagement with Non-State
Actors (FENSA).

Cross-border marketing of unhealthy products is a contributor to NCDs. Big

influential producers of unhealthy commodities now utilise digital platforms for
cross-border marketing. Their profits are based on marketing and the collection
of digital data, which allows targeting to an unprecedented extent; this include
targeting the most vulnerable in order to ensure they buy the products.

WHO’s advocacy efforts to prevent harmful use of alcohol should also target
political leadership because, in many countries, the alcohol industry, including the
informal industry, has close and powerful links to politicians, making it difficult to
effectively implement prevention policies.

With regard to behavioural risk factors other than tobacco, the evidence base on
cost-effective policies and interventions (best buys) needs broader dissemination,
and process and outcome indicators for tracking progress of implementation need
further development. There should also be better clarity about the conflict of
interest that exists in the branding of sports and cultural events by producers of
unhealthy commodities.

STAG-NCD recommends that:

In order for the WHO NCD programme to be better adapted to the range of
country contexts, WHO adopts the following measures:
Technical support

1. WHO should provide technical support and mentorship to countries, targeted

according to their financial and human resource capacity for implementation,
to help them to build political commitment and accelerate the national
response to NCDs.

2. WHO should provide technical guidance to countries to undertake costing

exercises, to incorporate NCD funding needs into the budget plans for the
COVID-19 recovery programmes, and to mobilize domestic finances to ensure
sustainability of NCD programmes, including through taxation of tobacco,
alcohol and unhealthy food and beverages.

3. WHO should provide further technical guidance to countries to strengthen

health information systems, including through the development of user-
friendly integrated NCD databases that are open source and capable of
accommodating individual data as well as facility-based data (at all levels
of care). These should be interoperable with other data systems, and with
telemedicine and mobile technologies. This includes a database of resource
personnel for capacity development of the PHC workforce and disease-based
registries, where appropriate.

11
 Monitoring

4. WHO should provide guidance and support to countries to strengthen

accountability and transparency by creating dashboards and reports that
use clear indicators to track country performance in implementing policies,
guidelines and national NCD indicators and in achieving process and clinical
outcomes, including in-patient outcomes.

5. WHO should encourage countries and donors to introduce and resource

shadow reporting from civil society to verify the implementation of NCD
policies and interventions, thereby providing an additional perspective on the
level of implementation.
Policy development

6. WHO should support countries to document their best practices and pathways
to policy success, and to analyse their political, economic, social landscape, so
that they can better tailor their policies and interventions, particularly during
the recovery phase of the COVID-19 pandemic.

7. WHO should further support countries to develop sustainable health financing

mechanisms and to integrate NCDs into UHC packages, thereby safeguarding
equity and sustainability.

8. WHO should support countries to develop fact sheets and other communication
tools, develop tax policies for sugar, salt and trans fats, and national investment
cases for addressing NCDs based on their own epidemiological context, cost-
effective solutions and return on investment.
Access to health care

9. WHO should provide further technical support to countries to improve access

to quality medicines, diagnostics and devices, including through WHO support
to strengthen national regulatory authorities, treatment optimization to help
focus markets on a core set of essential medicines, and technologies to increase
purchasing power and improve affordability.

10. WHO should continue to provide technical support to countries to increase

access to NCD care by bringing it closer to people’s homes, including through
team-based care, task shifting and sharing, and integration into primary health
care. This includes preventing heart attacks and strokes through sustainable,
cost-effective and integrated primary and secondary health care programmes,
using treatment of diabetes, hypertension, tobacco use and other risk factors as
entry points.

Session 3: What is required of STAG-NCD

Session 3 was chaired by Professor Veronika Skvortsova, supported by Dr Cherian
Varghese. The session brought together the global and regional NCD offices
and WHO departments covering different areas of NCDs. They made brief
presentations on what they require from STAG-NCD, summarized below.

WHO Regional Office for Africa – Dr Jean-Marie Dangou, coordinator, NCDs

• A mechanism to ensure that the three levels of WHO work as a single

coordinated entity to maximize the capacity of WHO;

• Advocacy and communication to accelerate implementation of existing

12
 initiatives, including NCD technical packages across all regions; and

• The addressing of human resource and funding gaps in the African regional
office to enable better support for the 47 country offices and ministries of
health.

WHO Regional Office for the Eastern Mediterranean – Dr Asmus Hammerich,

Director, NCDs

• Mobilization of resources to strengthen governance for NCD prevention and

control;

• Mechanisms to counteract industry influence on prevention;

• Strategies to improve access to quality services, including in countries in

conflict; and

• Better data on mortality, risk factors and service delivery.

WHO Regional Office for Europe – Dr Kremlin Wickramasinghe, a.i. Head, WHO
European Office for Prevention and Control of Noncommunicable Diseases (NCD
Office) and Adviser (Nutrition)

• Innovative mechanisms to motivate countries to move from policies to action;

• Documentation of country case studies that demonstrate the impact of NCD

policies;

• Policy review tools to assess the level of policy implementation;

• Benchmarking tools such as data dashboards to compare country performance;

and

• Tools to harness the power of digital technologies to scale-up NCD action.

WHO Regional Office for Europe – Dr Carina Ferreira-Borges, Regional Adviser,

Alcohol, Illicit Drugs and Prison Health

• How do we move forward on a broad NCD agenda with many diseases when
resources are limited?

• What is the best way of demonstrating the impact of NCD policies and the
interventions of this broad agenda?

WHO Regional Office for South East Asia – Dr Manju Rani, Regional Adviser
NCDs

• Guidance on public–private partnerships to scale up NCDs service delivery;

• Guidance on operationalizing multisectoral action and its accountability;

• Effective use of digital innovations to drive the NCDs agenda; and

• Easy-to-measure simplified indicators to demonstrate impact of policies and

interventions on NCDs.

WHO Headquarters – Dr Bente Mikkelsen, Director, NCDs

• Maximization of impact of WHO global initiatives, tools and technical packages;

• Increased coverage of NCD services through UHC; and

• Keeping NCDs high on the list of priorities in global and national health
agendas.

WHO Headquarters – Dr Svetlana Axelrod, Director, Global NCD Platform

• Highlighting of the role of the United Nations Interagency Task Force (UNIATF)

13
 on NCDs in influencing the UN system and for collective advocacy;

• Advocacy for mobilization of resources for the Multi-Partner Trust Fund;

• Dissemination of tools to facilitate multisectoral action and multi-stakeholder

engagement; and

• Dissemination of decision-making tool to guide collaboration with private-

sector entities.

Session 4: Improving diagnosis and

treatment, monitoring and surveillance
Session 4 was chaired by Dr Jennifer Cohn and supported Dr Slim Slama, Unit Head
(NCD).

Key question
WHO needs to better adapt its NCD programme to the range of country contexts
in which it works, in the COVID-19 and post-COVID-19 period.

Taking NCD-GAP mid-point evaluation recommendations 4 and 6 (see Table A3,

Annex 3) as the starting point, and framing them through the settings of low-,
lower-middle, upper-middle and high-income countries, the meeting considered
the following questions:

• How can Member States be supported to ensure that those affected by NCDs
are diagnosed and treated, using cost-effective and sustainable approaches to
improve health outcomes?

• How can Member States be supported to further strengthen monitoring and

surveillance of NCD responses?

STAG-NCD:
EMPHASIZES the importance of integrating NCD services with communicable
diseases, including COVID-19 services, taking cognizance of the limited financial
resources, health workforce shortfall, technology gaps and other country
realities. The interplay between NCDs and the pandemic has amplified the
need for health systems to be strengthened to deliver all core NCD services
and for to recognize the detection and treatment of NCDs as essential public
health functions. Efforts also need to be made to better diagnose and treat
hypertension and pre-eclampsia in pregnancy, including through integration of
NCD programmes with maternal and child health programmes, as appropriate,
recognizing that addressing hypertension in pregnancy will improve maternal
and foetal health outcomes and prevent low birth weight, which is a marker
of increased NCD risk in later life. A major push is needed to scale-up the WHO
best buy that focuses on early detection and treatment of hypertension and
diabetes through an integrated total-risk approach.

EMPHASIZES the need to promote procurement and use of safe, quality,

efficacious and affordable medicines, including generics, for treatment of NCDs,
given that medicines are one of the most expensive items for health systems,
particularly in LMICs that lack manufacturing capabilities. Tackling NCDs also
requires removing policy barriers to access of essential medicines, addressing
the disconnect between the availability of core NCD medicines and insurance

14
 coverage, facilitating access and quality assurance of basic diagnostics and
technologies, including point-of-care devices.

RECOGNIZES that health financing and insurance schemes need to first expand
coverage for high-impact, high-return NCD interventions (best buys) to
everyone, while eliminating out-of-pocket payments.

RECOGNIZES the need for meaningful engagement of civil society and people
living with NCDs, including, where appropriate, by strengthening civil society
alliances to raise awareness, strengthen advocacy, deliver services, contribute in
kind, and monitor progress and accountability.

RECOGNIZES the need to promote and facilitate international, interregional and

intercountry collaboration for exchange of best practices in the implementation
of best buys, multisectoral action, taxation of unhealthy products, legislation,
regulation of marketing of unhealthy commodities and pharmaceutical
promotion, health system strengthening, use of digital technologies and
training of health personnel, so as to disseminate learning from the experiences
of countries in meeting the challenges of NCD prevention and control.

RECOGNIZES the importance of promoting operational research to strengthen the

scientific basis for decision-making, in particular research designed to better
understand implementation capacity, feasibility and impact on health equity of
interventions and policy options contained in Appendix 3 to the NCD-GAP (6).

RECOGNIZES the convening power of WHO to mobilize bilateral and multilateral

donors, private sector, including the health insurance industry, ministries of
health, finance and other ministries and civil society organizations to work as
one within the scope of their respective mandates, to finance and scale-up NCD
best buys using integrated approaches and avoiding fragmentation.

NOTES that actions to tackle NCDs can be accelerated by constructively engaging

with some elements of the private sector – with the exception of producers
and marketers of unhealthy products, including tobacco and alcohol products,
and with due attention to the management of commercial and other vested
interests. Where it is possible to protect against any influence that would
reduce the likelihood of effective policies being developed and implemented,
to explore ways to accelerate NCD prevention and control, including through
public–private partnerships and strategic purchase of services.

NOTES that ministries of health need to take into account commercial and other
vested interests when working in partnership with the private sector, which
include: food and non-alcoholic beverage companies in areas such as labelling
and market regulation; the technology industry for improving access to quality
diagnostics, basic technologies for detection of NCDs and for harnessing mobile
and telemedicine technologies; the pharmaceutical industry for improving
access to affordable, quality-assured essential medicines, and the private health
care sector to regulate quality of care and to streamline and monitor patient
flows between public and private health sectors to make progress towards
UHC.

15
 STAG-NCD recommends that:
In order for the WHO NCD programme to be better adapted to the range of
country contexts, WHO adopts the following measures:
Diagnosis and treatment

11. WHO should continue to provide technical guidance for early detection and
treatment of diabetes, hypertension and other comorbidities through a primary
health care approach, avoiding fragmentation and promoting integration of
NCD services, engaging and empowering health care professionals, community
health workers, lay people, communities and providers of traditional medicine,
as appropriate.

12. WHO should further support countries to empower people to take an

enlightened interest in self-care by actively promoting health literacy, including
through effective public health and communication campaigns grounded in
behavioural science and responsive to local needs and contexts.
Health care provision

13. WHO should provide further technical support to countries to prioritize very
cost-effective, high-impact NCD interventions as core essential components
of a UHC basic benefits package. Several useful tools, including the updated
Appendix 3 “best buys”(7), the WHO Package of essential noncommunicable
(PEN) disease interventions (8), cardiovascular risk assessment charts and other
guidelines exist to support priority setting and development of the basic
benefits package. PHC services for slum and shanty dwellers and floating,
migrant populations in urban settings require special focus.

14. WHO should continue its work on enhancing the capacity of countries to address
NCDs, including through strengthening of the capabilities of the ministry of
health workforce in areas such as taxation, legislation, regulation, multisectoral
action, surveillance and monitoring, and by promoting the use of protocol-
based training of grassroot health care workers to accelerate delivery of quality
care for NCD management and COVID-19 recovery. Initiatives to strengthen
the capacity of the health workforce for NCD prevention and control should be
institutionalized and go beyond one-off training sessions provided by NGOs and
the pharmaceutical industry.

15. Given the resource limitations in LMICs, made worse by the COVID-19
pandemic, special attention should be paid to sustainability and equity of NCD
prevention and control programmes at all levels of health care. WHO should
consider the development of online NCD training programmes for community
health workers and continue to develop and support the uptake of simple,
where possible algorithmic, operational guidance for implementing best buys
for countries and other implementing partners.

16. WHO should provide technical support to ministries of health, finance, trade
and industry and other ministries and civil society organizations to work as one
within the scope of their respective mandates, to finance and scale-up NCD
best buys using integrated approaches, avoiding fragmentation and protecting
these initiatives from interference from commercial entities with conflicting
interests.
Monitoring and surveillance

17. WHO continues to support countries to effectively engage people living with
NCDs, embracing their involvement across governance, policy development,

16
 service design and delivery, and monitoring and evaluation, taking into account
conflicts of interest.

18. WHO should continue to support countries to develop responsive and robust
information systems for surveillance and monitoring of progress of NCD
prevention and control. This includes conducting regular STEPs surveys,
strengthening accuracy of death registration systems, reporting on national
targets and indicators based on the global monitoring framework, monitoring
implementation of best-buy policies and best-buy health system interventions
at all levels of care, and making better use of health-facility-based information
and introduction of electronic medical records, where feasible. A regularly
updated country-specific dashboard of key policy adoption and process, and of
clinical outcomes, would help increase transparency and accountability for all
stakeholders.

Session 5: Health diplomacy

Session 5 was chaired by Professor Veronika Skvortsova and supported by Dr Bente
Mikkelsen. Mr Menno Van Hilten, Cross-cutting Lead, NCD Strategy, presented
the background and set the scene for the session by introducing the concept of
health diplomacy. He explained the difference between Resolutions of the United
Nations General Assembly (UNGA) and the World Health Assembly (WHA). The
former are commitments from heads of state and governments, while the latter
provides guidance for implementing them. He reminded the participants that
there have been three high-level meetings (HLMs) – in September 2011, July 2014
and September 2018 – at which a total of 63 commitments have been made.

The fourth HLM will be in 2025. During the preparatory phase a series of meetings
will be held at which recommendations will be made. These will then analysed
in the UN Secretary-General’s report that is submitted to the UNGA in 2024. A
report is prepared by the WHO Director-General containing recommendations
to be discussed in the UNGA. Two ambassadors act as co-facilitators. The
recommendations are edited and a zero draft outcome document prepared
that forms the starting point of negotiations. After negotiation, the document
is adopted at the HLM. One of the most important outcomes of this health
diplomacy process for NCDs is SDG 3.4.

Health diplomacy can result in duplication of efforts. It works through political

consensus and over the last 10 years there has been no consensus on international
financing for NCDs, or for the commercial determinants of health or medicines.
These issues are difficult to solve through diplomatic approaches as economic,
trade and health interests may conflict with each other. Menno van Hilten outlined
the national commitments made at HLMs on governance, risk factors, health
systems and surveillance. HLMs have given various assignments to WHO that
have been delivered, including the global monitoring framework with targets
and indicators, the NCD-GAP 2013–2020 (9), currently being updated to 2030,
partnerships for NCD prevention and control (the Global Coordination Mechanism,
United Nations Interagency Task Force and the WHO/UNDP/UNICEF Multi-Partner
Trust Fund). WHO was also asked to develop an approach for the private sector
and NGOs to publish and register their contributions to national NCD responses,
which is under development. For the HLM in 2018, a high-level commission was set
up by the WHO Director-General. The commission issued six recommendations on:
leadership; prioritization and scaling-up; embedding and expanding NCD within

17
 PHC and UHC; collaboration and regulation; finance; and accountability for NCD
prevention and control.

The challenges and obstacles to NCD prevention and control have been discussed
in many meetings and in the reports of the UN Secretary-General. The key
obstacles are weak policy backbone and lack of knowledge to address commercial
determinants and implement tax-related measures; industry interference in
attempts to reduce risk factors; the difficulties of scaling up measures due to weak
capacity of health systems; and lack of interest in increasing international finance.

The following question was posed to STAG-NCD:

How could WHO better exercise its leadership and coordination role in the
preparatory process towards the fourth HLM of the UNGA on Prevention and
Control of NCDs in 2025, and the meeting itself, framed through:

• the status of the assignments given to WHO;

• the report of the UN Secretary-General and its recommendations (2024);

• the preparatory meetings, expected outcomes, and contributions; and

• the “asks” for the outcome document.

STAG-NCD proposes:
Preparatory activities

• Regional consultations in the lead up to the fourth HLM, to focus on regional

priorities and regional calls to action to feed into the outcome document.

• Engagement of regional political blocks (OECD, CARICOM, etc.) to build

capacity and technical understanding of the issues. Leveraging high-profile
meetings (e.g. meeting of the Commonwealth Ministers, Road Safety etc.) and
other summits (e.g.G7, G20) that take place before 2025, to draw attention to
the NCD agenda.
Reports

• Preparation of a snapshot report showcasing where countries are in terms of

implementation of commitments of previous HLMs and the achievement of
SDG 3.4. This could also include projections of progress into the future, using
modelling.

• Preparation of a civil society monitoring report, so that when governments

are reporting on progress, shadow reporting from civil society can provide an
additional perspective.
“Asks” in the outcome document

• To keep a strong focus on private-sector interference as a key obstacle to NCD

prevention and ways of mitigating it.

• To emphasize equity issues and human rights: e.g. for the same consumption
level of alcohol, greater harm is experienced by vulnerable groups than by
non-vulnerable groups, and women and children’s human rights are violated
because of increased severity of domestic violence and maltreatment of
children triggered by harmful use of alcohol.

• To focus on specific, time-bound national commitments with accountability

mechanisms rather than commitments at global level.

• To add granularity to asks of the outcome document: e.g. reduce premature

18
 mortality by providing equitable outpatient and in-patient care of heart attacks
and strokes and prevention of heart attacks and strokes using hypertension and
diabetes as entry points through a sustainable PHC approach.

Closing session
The closing session was chaired by Professor Veronika Skvortsova and supported
by Dr Bente Mikkelsen. Rapporteurs presented their reports summarizing the
strategic conversation and identifying key issues in relation to WHO’s work on NCD
prevention and control at global, regional and country level.

The devastating socio-economic and health impact of the COVID-19 pandemic,

and the interplay between the pandemic and the NCD epidemic requires WHO
to adopt innovative and results-oriented approaches to guide Member States
towards 2025 and 2030 targets. STAG-NCD acknowledges and applauds WHO’s
indispensable leadership on NCD prevention and control at global regional
and national levels, including by supporting countries through surveillance
and monitoring, providing technical guidance on evidence-based strategies,
strengthening multisectoral action, promoting research and innovation and,
through the meaningful engagement of civil society, affecting communities and
other partners.

The STAG-NCD is concerned and alarmed about the lack of awareness on national
agendas and acknowledgement on global agendas that:

• There is a causal relationship between underlying NCDs and COVID-19 fatality.

• COVID-19 has severely disrupted NCD services, leaving a backlog of patients
who require care.
• Funding to tackle the COVID-19 response in countries is not sensitive to
addressing co-morbidities from NCDs.
• Telehealth and mobile health programmes are not reaching community health
workers and hard-to-reach populations with information on the prevention
and management of NCDs.

• Underinvestment in health systems that meet the health-care needs of people

living with NCDs hinders both NCD prevention and control and pandemic
preparedness.

STAG-NCD welcomes:
• The WHO NCD implementation roadmap 2023–2030, including an NCD data
portal; heatmaps for countries to identify specific NCDs and their contribution
to the premature mortality; the web-based simulation tool; interventions for
NCDs that are updated with the latest evidence and aligned to PHC and UHC
frameworks;
• WHO guidance to promote policy coherence for NCDs and risk factors among
all relevant government sectors and involving relevant stakeholders;
• WHO guidance to support countries in making informed decisions on pursuing
meaningful multi-stakeholder collaboration, including with the private sector,
without conflicting interests and civil societies;
• WHO guidance for meaningful engagement of people living with NCD and
mental health conditions in the co-design of NCD policies, programmes, and
services;

19
 • An updated set of best buys and other recommendations for the prevention
and control of NCDs; and

• The new “business model” that will set out how WHO will work with countries
to provide country support (including strategic policy advice, technical
assistance) through “signature solutions”, special initiatives, and projects.

Draft outcomes from the sessions:

WHO leadership and core capacity

• WHO should continue exercising its leadership and coordination role, and
remain the credible leader in setting standards, promoting and monitoring
action for the prevention and control of NCDs in relation to the work of the UN
Development System and beyond, and providing global leadership at relevant
fora.

• WHO should use the power of purpose, the strength of multi-stakeholder

collaborations, new initiatives, global communications strategies and creative
storytelling to mobilize action, shape policies and define priorities for the
preparatory process leading to the fourth UN High-level Meeting.

• WHO should ensure that its actions to end COVID-19 (resources to tackle
the COVID-19 response, COVID-19 vaccination programmes, the pandemic
preparedness and response plans) and country efforts to build forward better
are sensitive to prevention of NCDs and to the needs of people suffering from
NCDs.

• WHO should support countries towards NCD targets, including SDG target 3.4,
through adequate and predictable funding for NCD prevention and control
programmes at all levels of WHO and for dedicated staffing in WHO country
offices.
Country support

• WHO should meet the demands for technical assistance from countries to adapt
and titrate WHO NCD packages and signature solutions to epidemiological,
health system and resource contexts, enabling all Member States to prioritize
and accelerate best buy interventions, with a focus on population-wide
prevention, rehabilitation, PHC and UHC.

• WHO should deliver results at the speed and scale needed to reach SDG 3.4
by 2030 through strengthening partnerships and coalitions to promote the
roll-out of the WHO NCD implementation roadmap 2023–2030. This includes
strategic partnerships to improve access to medicines and technologies, for
implementation research, and capacity-building initiatives to strengthen
the health workforce, including community health workers in particular,
for population-wide prevention of NCD and service delivery through a PHC
approach.

• WHO should support countries to increase investment in NCD prevention and

control through domestic financing, including through health taxes, and to
mobilize external aid from international financial institutions and development
cooperation agencies.
Health promotion

• WHO should address the social, political and commercial risk factors for
NCDs through health promotion advocacy, technical assistance, and global
governance mechanisms to increase accountability, evidence and research. Fast

20
 technology developments need to be addressed with regard to their potential
benefits and risks. WHO should make it a priority to address cross-border
marketing of unhealthy products in digital media, and industry interference to
weaken effective policy.
Digital health and innovation

• WHO should use lessons learned in the COVID-19 pandemic to support

countries to scale up telehealth, mobile health and other digital technologies
to strengthen health literacy, advocacy for NCD prevention and empowerment
of communities, and to train and assist community health workers to provide
equitable NCD care to remote populations.
Data and impact

• WHO should provide further support to strengthen national health information

systems, surveillance and monitoring to generate reliable and timely data to
prioritize and track implementation of NCD policies and interventions across the
full spectrum of NCDs and to assess the impact.
Partnerships

• WHO should engage and energize civil society, including people living with
NCDs, to scale up shadow reporting of physical activity, alcohol, tobacco and
food-related corporate public relations and industry interference, and to
mobilize political support to redress the underinvestment in NCD prevention
and control.

The STAG-NCD Chair, Professor Veronika Skvortsova, presented the draft outcomes
to WHO Director-General Dr Tedros Adhanom Ghebreyesus, who joined the first
STAG-NCD meeting during the closing session. He thanked the members for serving
in the group and for their advice to WHO to strengthen NCD prevention and
control to accelerate action at global, regional and country levels to attain SDG
target 3.4.

Plans for the 2022 STAG-NCD meetings

The WHO Secretariat announced that the second and third meetings of STAG-NCD
will be held at WHO Headquarters in Geneva Switzerland in June and November
2022.

Closing remarks
The meeting was closed with final remarks and appreciation to all participants
offered by Dr Bente Mikkelsen on behalf of WHO, and by Professor Veronika
Skvortsova on behalf of the STAG-NCD.

This document is a report of a first meeting of an external advisory group, and

is the product of virtual deliberations. It represents the opinions of members
of the STAG-NCD and is a work in progress. It is not meant to represent the
position or opinions of WHO or its Member States, nor the official position of
any WHO staff members.

21
 References
(1) Mid-point evaluation of the implementation of the WHO global action plan
for the prevention and control of noncommunicable diseases 2013–2020 (NCD-
GAP). Geneva: WHO; 2020 (https://www.who.int/publications/m/item/mid-point-
evaluation-of-the-implementation-of-the-who-global-action-plan-for-the-
prevention-and-control-of-noncommunicable-diseases-2013-2020-(ncd-gap) ).
(2) First global Ministerial Conference on Healthy Lifestyles and Noncommunicable
Disease Control, 28–29 April 2011. Moscow Declaration (https://www.who.int/
nmh/events/moscow_ncds_2011/conference_documents/moscow_declaration_
en.pdf).
(3) United Nations General Assembly. Resolution A/RES/75/130: Global health and
foreign policy: strengthening health system resilience through affordable health
care for all. New York: United Nations; 2020 (https://undocs.org/en/A/RES/75/130).
(4) Implementation roadmap 2023-2030 for the global action plan for the
prevention and control of NCDs 2013-2030 [website] (https://www.who.int/teams/
noncommunicable-diseases/governance/roadmap).
(5) Mid-point evaluation of the implementation of the WHO global action plan, op
cit.
(6) “Best buys” and other recommended interventions for the prevention and
control of noncommunicable diseases. Updated (2017) Appendix 3 of the
Global action plan for the prevention and control of noncommunicable diseases
2013–2020. Geneva: World Health Organization; 2017 (https://www.who.int/ncds/
management/WHO_Appendix_BestBuys.pdf).
(7) ibid.
(8) Package of essential noncommunicable (PEN) disease interventions for primary
health care in low resource settings. Geneva: World Health Organization; 2010
(https://www.who.int/nmh/publications/essential_ncd_interventions_lr_settings.
pdf).
(9) Global action plan for the prevention and control of NCDs 2013-2020.
Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/
item/9789241506236).

22
Annex 1: Agenda for STAG-NCD first meeting
First meeting of the Strategic and Technical Advisory Group (STAG) for NCDs
27–28 October 2021
WHO Headquarters – Geneva, Switzerland (Virtual)

WEDNESDAY 27 October 2021

Session 1 Welcome and opening remarks Dr Ren Minghui
13:00–13:40 Nomination of Chair, Co-chair and rapporteurs Dr Naoko
Adoption of agenda Yamamoto
Welcome remarks – Chair Dr Bente
Setting the scene, scope, and purpose Mikkelsen
Dr Ruediger Krech
Session 2 Introduction by STAG members (3 minutes each) on STAG-NCD
their vision and contribution to the STAG-NCD members in
13:40–15:00
alphabetical order
15:00–15:15 BREAK
Session 3 Question 1 How could the WHO NCD programme be STAG-NCD
better adapted to the range of country contexts in members
15:15–16:45
which it works in the COVID-19 pandemic and post-
COVID-19 period, framed through the settings of low-,
lower-middle, upper-middle and high-income countries,
including through operationalization of the following
mid-point evaluation recommendations of the NCD-
GAP:
• Get Member States to focus the limited financial
resources available for NCDs on the most cost
effective NCD interventions and to raise resources for
scale-up, considering the impact of COVID-19.
• Explore why progress seen in relation to addressing
tobacco use has not yet been seen in relation to
other risk factors-harmful use of alcohol, unhealthy
diet and physical inactivity.

16:45–17:00 Summary of day 1 and plan for day 2 Co-chair

THURSDAY 28 October 2021

Session 4 NCD directors in HQ and the regions – what is their ask Directors covering
from STAG-NCD? NCD prevention
13:00–14:00
and control in HQ
and regions

23
 Session 5 Question 1: How could the WHO NCD programme be Discussion by STAG
better adapted to the range of country contexts in members
14:00–15:00
which it works in the COVID-19 pandemic and post-
COVID-19 period, framed through the settings of
low-, lower-middle, upper-middle and high-income
countries, including through operationalization of the
following mid-point evaluation recommendations of
the NCD-GAP:
• Support Member States more to ensure that those
affected by NCDs are diagnosed and treated to
improve health outcomes, using very cost effective
and sustainable approaches.
• Support Member States to further strengthen
monitoring and surveillance of NCD responses.

15:00–15:15 BREAK

Session 6 Question 2: How could WHO better exercise its Discussion by STAG
leadership and coordination role in the preparatory members
15.15– 15.45
process towards the fourth High-level Meeting of the
United Nations General Assembly on the Prevention
and Control of NCDs in 2025, and the meeting itself,
framed through:
• The status of the assignments given to WHO
• The report of the UN Secretary-General and its
recommendations (2024)
• The preparatory meetings, expected outcomes, and
contributions
• The “asks” for the outcome document.

15:45–16:15 Recommendations Rapporteurs

Review of recommendations and plan for presentation

16:15–16:30 Chair and Co-chair
to the DG
Presentation of the recommendations to the Director-
16:30–17:00 Chair
General from the first meeting of the STAG-NCD
Dr Bente
17:00–17:30 Plan for the next meeting and closing remarks
Mikkelsen

24
Annex 2: List of participants
Dr Mary Amuyunzu- Vice-President for the African Region, International Union for
Nyamongo Health Promotion and Education
Dr Baffour Awuah Kumasi Cancer Registry, Ghana
Dr Sally Casswell Professor and Director of SHORE, New Zealand
Chief Professor, Division of Endocrinology & Metabolism,
Dr Sung Hee Choi Internal Medicine, Seoul National University Bundang
Hospital, Republic of Korea
Clinical Assistant Professor of Infectious Diseases, Center for
Dr Jennifer Cohn Global Health, University of Pennsylvania School of Medicine,
United States of America
Ms Katie Dain CEO, NCD Alliance
Full Professor of the Faculty of Medicine, Eduardo Mondlane
Dr Albertino Damasceno
University, Maputo, Mozambique
Founder and Chair of the Eastern Mediterranean NCD
Dr Ibtihal Fadhil
Alliance
Deputy Director (NCD), Disease Control Division, Ministry of
Dr Mustapha Feisul
Health, Malaysia
Former Director, Primary Health Care, Ministry of Health and
Dr Khaleda Islam
Family Welfare, Bangladesh
Ms Jordan Jarvis Health policy researcher and advocate
Professor and Director, NCD Unit, Medical Research Council,
Dr Andre Pascal Kengne
South Africa
Professor and Founding President, Chief Scientific Officer,
Dr Bagher Larijani Endocrinology and Metabolism Research Institute, Iran
(Islamic Republic of)
Associate Professor of Health Policy and Director of the
Mr Claudio Méndez
Instituto de Salud Pública, Universidad Austral, Chile
Dr Bo Norrving Senior Professor in Neurology, Lund University, Sweden
Principal (Dean) and Professor of Neurology at Christian
Dr Jeyaraj Pandian
Medical College Ludhiana, Punjab, India
Caribbean Institute for Health Research, University of the
Dr Alafia Samuels
West Indies, Jamaica
General Director of Health Programs and Chronic Diseases,
Dr Alomary Shaker
Ministry of Health, Saudi Arabia
Dr Veronika Skvortsova Professor, Former Minister of Health, Russian Federation
Director, International Health Policy Programme, Ministry of
Dr Thaksaphon Thamarangsi
Health, Thailand
Professor, Vice President of the Academy of Engineering,
Dr Chen Wang President of Academy of Medical Science, and President of
the Peking Union Medical College, China
Dr Champika Wickramasinghe Deputy Director-General, NCDs, Ministry of Health, Sri Lanka

25
 WHO headquarters
Assistant Director-General, Division of UHC/ Communicable
Dr Ren Minghui
and Noncommunicable Diseases
Dr Naoko Yamamoto Assistant Director-General for Healthier Populations
Dr Bente Mikkelsen Director, WHO Global NCD Programme
Dr Ruediger Krech Director, Health Promotion
Dr Svetlana Axelrod Director, Global NCD Platform
Dr Cherian Varghese Cross-cutting Lead NCD and special initiatives.
Mr Menno Van Hilten Cross-cutting Lead, NCD Strategy
Dr Slim Slama Unit Head (NCD)
Dr Temo Waqanivalu NCD Integrated Services Lead
Dr Leanne Riley Head of Surveillance, Monitoring and Reporting
Dr Shanthi Mendis Consultant (NCD)
Ms Nicoletta De Lissandri Senior Assistant to Director

WHO regional offices

Dr Jean-Marie Dangou Coordinator, NCD, WHO African Region
Dr Asmus Hammerich Director NCD, WHO Eastern Mediterranean Region
a.i. Head, WHO European Office for Prevention and Control
Dr Kremlin Wickramasinghe
of NCDs and Adviser (Nutrition)
Dr Carina Ferreira-Borges Regional Adviser, Alcohol, Illicit Drugs and Prison Health
Dr Manju Rani Regional Adviser NCD, South–East Asia Region

26
Annex 3: Background paper to first
meeting of the STAG-NCD group
The World Health Organization (WHO) established the Strategic and Technical
Advisory Group on the Prevention and Control of Noncommunicable Diseases
(STAG-NCD) in October 2021(1). The STAG-NCD has 24 members and acts as an
advisory body to WHO’s Director-General to further WHO’s efforts and work
in addressing the prevention and control of NCDs. The aim is to strengthen
international and national action in these important public health areas and,
thereby, (a) reduce premature mortality from NCDs through prevention and
treatment (2); (b) progressively cover additional people with health services,
medicines, vaccines, diagnostics and health technologies (3); and (c) strengthen
efforts to address NCDs as part of Universal Health Coverage (UHC) (4).

In this capacity, the STAG-NCD has the following functions:

• To identify and describe current and future challenges;

• To advise WHO on strategic directions to be prioritized;

• To advise WHO on the development of global strategic documents; and

• To propose other strategic interventions and activities for implementation by

WHO.

The STAG shall normally meet once each year. However, WHO may convene
additional meetings. STAG meetings may be held in person (at WHO headquarters
in Geneva or another location, as determined by WHO) or virtually, via video or
teleconference.

Scope and purpose

This background paper summarizes the key milestones in the development of the
global public health agenda for addressing NCDs over the last two decades. It
outlines where the world is and where the world wants to be in NCD prevention
and control in a decade. It presents the challenges in achieving the internationally
agreed NCD goals and targets for 2025 and 2030, the interconnected commitments
made by countries, technical guidance provided by WHO and the role of the civil
society and the private sector in contributing to the implementation of national
NCD responses.

The purpose of the document is to provide the necessary background information

and key questions to guide the discussions of the first meeting of STAG-NCD. It
covers the following.

• The commitments made by governments on prevention and control of NCD at

the World Health Assembly (WHA) and the United Nations General Assembly
(UNGA);

• The guidance provided by WHO as requested by WHA on how to realize those

commitments, in particular the WHO Global Strategy for NCD prevention
and control, WHO Global NCD Action Plan (NCD-GAP), best buys and other
recommendations;

• The dynamics that have shaped the global NCD agenda and trajectory since
2011;

• Where the world stands today and where the world is aiming to go by 2030;

27
 • Key challenges for the implementation of NCD-GAP 2013–2030;

• Main recommendations of the mid-point evaluation of NCD-GAP; and

• The NCD roadmap.

NCD prevention and control

Governments have made commitments on the prevention and control of NCDs
which are included in the 2011, 2014 and 2018 Political Declarations of the UNGA
on the Prevention and Control of NCD (5, 6, 7), the 2013 Global NCD Action Plan (8),
the 2019 Political Declaration on UHC (9), and the 2030 Sustainable Development
Goals (SDG) (10).

These include:

• Exercise strategic leadership of heads of state and government to address NCDs

by promoting a whole-of-society response;

• Scale up implementation of the commitments to address NCD as part of the

national response to the implementation of the 2030 Sustainable Development
Agenda;

• Accelerate efforts towards the achievement of UHC by 2030 to ensure healthy

lives and promote wellbeing for all throughout the life-course;

• Strengthen national multistakeholder dialogue mechanisms with accountability

for the implementation of national multisectoral NCD action plans;

• Implement policy, legislative, regulatory and fiscal measures to minimize

exposure to behavioural risk factors; and

• Prioritize and integrate the set of cost-effective, affordable and evidence-based

NCD interventions (WHO best buys) to prevent and manage NCD.

One decade after the 2011 first High-level Meeting of the UNGA on the prevention
and control of NCD, new data from WHO shows that the NCD targets are not just
aspirational but achievable:

• In 2019, 42% of Member States had the ability to report on progress in

attaining the nine voluntary global NCD targets using data from risk-factor
surveys and cause-specific mortality systems (11);

• In 2019, 14 Member States were on track to achieve a 33% reduction in risk

of premature mortality from NCD by 2030 against a 2015 baseline (SDG target
3.4.1) (12).

To provide guidance to Member States, international partners and WHO on how

to realize these commitments, the WHA endorsed the global strategy for the
prevention and control of NCDs in May 2013 (resolution WHA66.10) (13). In line
with the 2011 Political Declaration on NCDs, the strategy presented a pragmatic
public health approach for addressing NCDs by focusing on four major NCDs
(cardiovascular disease, cancer, chronic respiratory disease, diabetes) that can be
prevented by mitigating four modifiable risk behaviours (tobacco use, harmful use
of alcohol, physical inactivity and unhealthy diet), shared by them. The strategy
recognizes that the global NCD burden cannot be addressed in a sustainable
manner through a single disease or a single risk factor focus. It also reiterates the
critical need for a synergistic combination of population-based and health-system
approaches to prevent and control NCD. Further, the strategy emphasizes the
potential for prevention of NCDs through reduction of exposure of populations to
lifestyle and environmental risk factors throughout the life-course.

28
Fig. A1 WHO NCD framework

It’s time to deliver on the promises made at the UNGA and develop
ambitious national NCD responses for achieving SDGs 3.4 and 3.8

Implementation roadmap 2023–2030

By 2030, reduce by one third premature mortality from NCDs (2015 baseline)

2030 milestone: 9 targets extended to 2030 (2010 baseline)

2025 milestone: 9 voluntary global NCD targets (2010 baseline)

Components of national NCD responses

Governance Risk factors Health systems Surveillance

2011 UN Political Declaration, WHO Global Best buys and other

2014 Outcome Document, and NCD Action Plan recommended ECOSOC
2018 Political Declaration on NCDs 2013–2030 interventions
2019 Political Declaration on UHC
WHO signature
Commitments made by governments at UNGA WHO GPW13
solutions
Guidance provided by WHA on how to realize the commitments made

In 2013, to accelerate national efforts to address NCDs, the WHA adopted

a comprehensive global monitoring framework with 25 indicators and nine
voluntary global targets for 2025 (Fig. A1). The WHA endorsed a set of actions
organized around the WHO Global Action Plan for the Prevention and Control of
NCDs 2013–2020 (NCD-GAP) which, when implemented collectively by Member
States, international partners and WHO, help to achieve the commitments made
by world leaders in September 2011. The set of actions is organized around six
objectives, aimed at strengthening national capacity, multisectoral action to
reduce exposure to risk factors, health systems, international co-operation, and
the monitoring of progress in attaining the nine voluntary global NCD targets
(Table A1).

Table A1. Nine voluntary global NCD targets

Nine voluntary global NCD targets

1. One third relative reduction in the overall mortality from CVD, cancer,
diabetes or CRD
2. At least 10% relative reduction in the harmful use of alcohol.
3. A 15% relative reduction in prevalence of insufficient physical activity
4. A 30% relative reduction in mean population intake of salt/sodium
5. A 30% relative reduction in prevalence of current tobacco use

29
 6. A 25% relative reduction in the prevalence of raised blood pressure or
contain the prevalence of raised blood pressure,
7. Halt the rise in diabetes and obesity
8. At least 50% of eligible people (age 40 years and older with a 10-year
cardiovascular risk ≥20%) including those with CVD to receive drug therapy
and counselling (including glycaemic control) to prevent heart attacks and
strokes
9. An 80% availability of the affordable basic technologies and essential
medicines, including generics, required to treat major noncommunicable
diseases in both public and private facilities

In September 2015, world leaders adopted a set of 17 Sustainable Development

Goals (SDGs), with associated targets, including one for NCDs, SDG 3.4 (14). SDG
target 3.4 is defined as: “By 2030, reduce by one third premature mortality from
NCDs through prevention and treatment and promote mental health and well-
being.” This target of a 33.3% relative reduction in the probability of dying from
the four main NCDs was aligned to the NCD mortality target within the Global
Monitoring Framework and is measured against 2015 as the common baseline set
for all SDGs (15).

In May 2018, the 71st World Health Assembly adopted the Global Action Plan on
Physical Activity 2018–2030, which included a target of “a 15% relative reduction
in the global prevalence of physical inactivity in adults and in adolescents by
2030” (16). This target was aligned to the physical activity target within the Global
Monitoring Framework, and proposed an extension by five years to 2030.

The Global action plan for the prevention and control of NCDs 2013–2020
(17) (NCD-GAP) comprises a menu of policy options and cost-effective and
recommended interventions (“Appendix 3”) to assist Member States, as
appropriate for their national context, in implementing measures towards
achieving SDG Target 3.4. Appendix 3 has been updated to take into consideration
the emergence of new evidence of cost-effectiveness and the issuance of new
WHO recommendations that show evidence of effective interventions. An updated
Appendix 3 was endorsed in May 2017 by the Seventieth WHA. It comprises a total
of 88 interventions, including overarching/enabling policy actions, cost-effective
interventions, and other recommended interventions. Sixteen of them are
considered to be the most cost-effective and feasible for implementation, with an
average cost-effectiveness ratio of ≤I$100/DALY averted in low- and lower-middle-
income countries (best buys) (18).

Heads of states and governments adopted the Political Declaration of the

High-level Meeting of the UNGA on the Prevention and Control of NCDs on 20
September 2011 (19). It is widely recognized as a major milestone in the global
fight against NCDs. The Political Declaration acknowledged that NCDs undermine
social and economic development throughout the world and recognized the
primary role and responsibility of governments in responding to the challenge,
engaging all sectors of society. It was a significant beginning in the fight against
NCDs and provided the impetus for placing NCDs high on the global political,
health and development agendas. The Political Declaration reiterated the
importance of implementing the WHO Framework Convention on Tobacco
Control, the Global Strategy for the Prevention and Control of NCDs as well as the
Global Strategy on Diet, Physical Activity and Health and the Global Strategy to
Reduce the Harmful Use of Alcohol.

30
It also triggered a chain of dynamics that shaped the NCD trajectory in the last
decade. The WHO NCD-GAP (20) followed from commitments made in the Political
Declaration on NCDs. The NCD-GAP provides a roadmap and a menu of policy
options for addressing NCDs for Member States and other stakeholders. The
NCD-GAP, and the actions that flowed from it in the last decade, have helped
countries to make progress in addressing NCDs (21). Some mechanisms and global
events which have contributed to this include (a) the adoption of commitments
at the UN General Assembly in 2014, 2015, 2018 and 2019 on the prevention and
control of NCDs; (b) the establishment of the United Nations Inter-Agency Task
Force on the Prevention and Control of NCDs (UNIATF) in 2014 for coordination
of UN activities to support national NCD responses (22); (c) the establishment
of a global coordination mechanism on the prevention and control of NCDs by
the WHA in 2014 (23); (d) inclusion of NCDs in SDG target 3.4 of the Sustainable
Development Agenda in 2015 (5); (f) the Addis Ababa Action Agenda on Financing
for Development in 2015 (24); (g) the appointment of a Global Ambassador for
NCDs and Injuries in 2016; (h) the establishment of an independent High-level
Commission on NCDs by the WHO Director-General in 2017 (25); and (i) the Global
Conferences on NCDs, in Montevideo, Uruguay in 2017 and Muscat Oman in 2019.

In addition, two global health movements have shaped the pathways to

prevention and control of NCDs and steered the associated political agenda. One
is the focus on primary health care and the other is the pursuit of UHC (26). They
have steered countries towards seeking the right balance between progressively
covering additional people with nationally determined sets of health services
including for NCDs, while strengthening primary health care as the foundation of
a sustainable health system for UHC.

The Seventy-second WHA extended the period of the NCD-GAP to 2030, ensuring
alignment with the 2030 Agenda for sustainable development and the SDGs
(27). WHO is tracking the implementation of NCD-GAP across its six objectives by
monitoring and reporting on nine process indicators and 10 progress monitoring
indicators (28).

In May 2018, WHO announced the Triple Billion targets of the Thirteenth General
Programme of Work (GPW13): a shared vision among WHO and Member States,
which helps countries to accelerate the delivery of the SDG (29). The targets are to
ensure that by 2023: one billion more people enjoy better health and well-being,
one billion more people benefit from universal health coverage and one billion
more people are better protected from health emergencies.

In 2020, a comprehensive mid-point evaluation of the progress achieved in the

implementation of the NCD-GAP was conducted, as mandated by resolution
WHA66.10 (30). The evaluation has issued a set of recommendations to strengthen
WHO’s global and national action for prevention and control of NCDs. The task
now is to accelerate implementation of the NCD-GAP 2013–2030, taking these
recommendations and GPW13 into consideration, recognizing that the COVID-19
pandemic has undone years of progress on NCD and SDG.

Where the world stands today and where the world is

aiming to go by 2030
Deaths from NCDs are on the rise. The global share of NCD deaths among all
deaths increased from 61% in 2000 to 74% in 2019 (31). At a global level, seven
of the 10 leading causes of deaths in 2019 were NCDs (32). Trends in deaths from
NCDs in all age-groups were driven by diverse changes across regions in 2000–
2019. Globally, the greatest decline in mortality was seen for chronic respiratory

31
 diseases, with a 37% decline for all ages, followed by cardiovascular diseases (27%)
and cancer (16%) (33). However, the progress is not comparable to that made for
curbing communicable diseases and is unequal across regions and income groups
(34). Diabetes has shown an unfavourable trend, with a 3% increase (35).

Deaths from NCDs between the ages of 30 and 70 – the most economically
productive age span – are classed as “premature” deaths, and are rapidly
increasing (36) (Table A2). Cardiovascular diseases continue to be the main NCDs,
claiming the largest number of lives among people in the 30–70 age group (37).
The majority of premature deaths from NCDs (85%) in 2019 occurred in low- and
middle-income countries (38).

Table A2. Deaths from NCDs between the ages of 30 and 70 (2000 to 2019)

2000 2010 2015 2019

(millions) (millions) (millions) (millions)
>70 years of age 16.8 19.9 21.8 23.8
30–70 years of age 12.7 13.7 14.7 15.7
<30 years of age 1.7 1.5 1.4 1.4
Total deaths 31.2 35.1 37.9 40.9

The risk of dying between the ages of 30 and 70 years from any of cardiovascular
disease, cancer, diabetes, or chronic respiratory disease has dropped over one fifth
from 22.9% in 2000 to 17.8% in 2019 (39). Despite the reduction achieved at the
start of this century, this progress has not been sustained. The global annualized
rate of reduction in premature NCD mortality has declined by 30% since 2015, to
just below 1% (from the 1.4% observed between 2000–2015) (40). WHO regions
that had already achieved relatively low premature NCD mortality by 2019
show the highest rate of decline since 2015. The declines were up to 40% in the
Region of the Americas and the Western Pacific Region, and up to 30% in the
European Region. In contrast, regions with the highest premature NCD mortalities
by 2019 showed rapid decreases in mortality during 2015–2019. For example,
the annualized rate of reduction increased 14% in the South-East Asia Region
and 86% in the Eastern Mediterranean Region. Premature mortality from NCDs
parallels, and can partly be attributed to, a lack of success in addressing many NCD
risk factors. Although tobacco use is steadily declining, the prevalence of obesity is
on the rise, and reduction in harmful alcohol consumption has stagnated globally
(41) and is increasing in the Americas, South-East Asia and the Western Pacific
regions (42).

In February 2021, most countries reported disruptions in services related to

NCDs (37%). These disruptions relate to screening, prevention, treatment and
rehabilitation services (43). Preliminary estimates suggest the total number of
global deaths attributable to COVID-19 in 2020 due to these disruptions to be at
least 3 million, with similar estimates expected for 2021.

32
Key challenges for the implementation of NCD-GAP 2013–
2030
The mid-point evaluation of the NCD-GAP identified many future challenges for
NCD prevention and control across each of the six NCD-GAP objectives (44). Some
of these challenges are summarized below.
Inadequate resources for implementation of NCD-GAP

Raising the profile of NCD has contributed to an increase in the number of

countries that have adopted a national NCD action plan since 2013. Sustainable
funding mechanisms are required for accelerated implementation of national
NCD plans. The COVID-19 pandemic that emerged in early 2020 occurred against
a backdrop of underinvestment in NCD prevention and control. The pandemic
has caused major disruptions to NCD service delivery and will continue to exert
a negative impact on NCD activities for many years. Member States have the
challenging task of identifying and leveraging the domestic financial resources
needed to respond effectively to NCDs. Priority resource allocation should be
accorded to high impact/good return NCD interventions. External donor assistance
could be usefully utilized to strengthen health systems rather than for initiating
vertical/single disease programmes. In the long-term, as responsibility for funding
health programmes shifts from external donors towards domestic resources,
maintaining an array of vertical programmes, particularly at the primary care level
is unlikely to be sustainable for LMIC governments. Another key challenge is to
provide WHO with adequate financial and human resources to provide technical
support to implementation of the NCD agenda, particularly at the country level.
Inadequate capacity for country response including multisectoral action

There is a statistically significant association between performance on WHO

NCD progress indicators and country income group, with high-income countries
performing better than LMICs. In LMICs there is a severe shortage of financial and
human resources to implement national NCD action plans, even when condensed
down to a smaller number of 16 high-impact best buys. Per capita spending on
health is $40 (38–43) in low-income countries, $81 (74–89) in lower-middle-income
countries, $491 (461–524) in upper-middle-income countries and US$5252 (5184–
5319) in high-income countries (45).

Joint work among different ministries and departments at country level is essential
to achieve the NCD agenda as well as the GPW13 and SDGs. Partnerships also
need to be forged with other stakeholders, such as civil society and the private
sector. As of 2019, fewer than half of all countries had a high-level mechanism
to facilitate multisectoral action. Even in countries where such mechanisms are
in place, they do not seem to be associated with the benefits expected, partly
due to inappropriate composition and suboptimal functioning of multisectoral/
multistakeholder groups.
Impediments to reducing exposure to modifiable risk factors

Lack of supportive legal frameworks, insufficient implementation of laws that

exist, industry interference, influence of vested commercial interests obstructing
effective regulatory legal frameworks on tobacco, alcohol and healthy eating,
and poor organization of civil society are impediments to reducing population
exposure to risk factors. Multisectoral engagement, for example beyond the
health sector and with the private sector, requires people with appropriate
political, diplomatic and networking skills and experience. In some countries,
staff in the Ministry of Health lack the necessary skills, experience and specific

33
 technical knowledge e.g. on taxation of sugar-sweetened beverages. Incremental
progress has been made in addressing tobacco use, primarily due to the WHO
Framework Convention on Tobacco Control (WHO FCTC) and the monitoring of
its implementation. Similar progress is not yet evident with other risk factors,
including harmful use of alcohol, healthy diet and physical activity.

Complexities in embedding NCD in UHC

Each year, about 100 million people are pushed into extreme poverty because
of out-of-pocket spending on health. Current government spending on health,
particularly in many LMICs, is not adequate for achieving UHC. While some
progress has been made on early diagnosis of NCDs and access to essential NCD
medicines, more work is needed to ensure that NCDs are managed effectively and
equitably through primary care. One of the major challenges to the development
of UHC is the rising prevalence of NCDs, partly driven by the ageing of
populations. There is a need to define specific requirements for NCD management
within the UHC and PHC agendas in terms of integration, multisectoral PHC
policy, financing, workforce competencies, essential services packages, service
delivery models, health information systems and access to diagnostics and
medicines. Efforts have been made to include NCDs in the basic primary health
care packages offered in different settings. Given that resources are limited and
NCDs comprise a large number of diseases and risk factors, the process has to be
incremental, starting with NCDs that can be treated through high-impact/high-
return interventions, and gradually expanding to include other comorbidities and
NCD interventions. The mid-point evaluation of NCD-GAP recognizes the crucial
importance of using integrated approaches and not solely focusing on a single
NCD or a risk factor.
Lack of investment in implementation research

Investment in and support for NCD research is suboptimal, despite the recognition
that there are still many evidence gaps, for example in terms of how best to
promote implementation of high-impact/high-return interventions (best buys),
depending on the contexts. In 2015, just over one fifth of countries (22%) had
an operational policy and plan on NCD research. By 2019, around two thirds of
countries still lacked such a policy. In 2019, only four low-income countries had
such a policy (46). Most of the improvement that occurred between 2015 and 2019
in NCD research was in high-income countries. The vacuum created by limited
engagement of WHO in NCD research is currently being filled by the private
sector e.g. pharmaceutical and food industry. This raises concerns about conflict
of interest, particularly as some sectors, e.g. tobacco, has used research to seek to
gain undue influence.

In addition to limited funding for research, another major reason for low research
output is the disparity in scientific capacity between high-income and low-income
countries. According to the United Nations Educational, Scientific and Cultural
Organization (UNESCO) and Eurostat, high-income countries have approximately
50 times more health researchers per million inhabitants (349) than low-income
countries (7), ranging (across the 81 countries) from 1,209 in Singapore to 0.2 in
Zimbabwe (47).
Weak surveillance and monitoring systems

In addition to the nine voluntary global targets in the NCD-GAP, there are 25
health outcome indicators within a global monitoring framework, a further nine
action plan implementation progress indicators and 10 commitment fulfilment

34
progress indicators. Member States regularly report on the progress they are
making in implementing their national NCD responses (48, 49). STEPS surveys have
been conducted in 120 countries, but few are able to repeat them every five years,
as recommended by WHO (50). In 2019, only around a third of countries had a
functioning system for generating reliable cause-specific mortality data. Whether
they did have a functioning system is largely related to country-income group; no
low-income country had such a system, as compared to more than three quarters
of high-income countries (78%).

The indicators on risk-factor surveys and cause-specific mortality systems are

combined to give an assessment of the extent to which a country will be able
to report against the voluntary global NCD targets. In 2019, more than half of
countries (58%) have not yet considered able to report against these targets,
making any final evaluation of the NCD-GAP a challenge (51). Monitoring progress
in NCD prevention and control with reliable and actionable data depends on
strong country data and health information systems. There are large gaps in the
availability of NCD data in many countries. Strengthening country capacity for
data and information remains a major challenge.

Mid-point evaluation of NCD-GAP; recommendations for WHO

Main recommendations for WHO across the six objectives of NCD-GAP are
summarized in Table A3.

Table A3. Recommendations of the mid-point evaluation of NCD-GAP

NCD-GAP 0bjective 1: To raise the priority accorded to the prevention

and control of NCDs in global, regional and national agendas and
internationally agreed development goals, through strengthened
international cooperation and advocacy
R1. WHO Secretariat and Member States to find sustainable funding
mechanisms to allow for a dramatic acceleration of NCD implementation.
WHO Secretariat to:
• develop proposals as to how NCD funding can be incorporated into plans to
build back better;
• continue to work with the OECD to introduce a purpose code to track
spending on NCDs within overseas development assistance (ODA); and
• introduce, with UNIATF and international partners, a Catalytic/Multi-Partner
Trust Fund for NCDs.

NCD-GAP objective 2: To strengthen national capacity, leadership,

governance, multisectoral action and partnerships to accelerate country
response for the prevention and control of NCDs
R2. WHO Secretariat and Member States to consider how best to use limited
financial resources available for NCDs by focusing on the most cost-effective
options based on available evidence.
WHO Secretariat to:
• provide technical support to Member States to help focus domestic financial
resources on those actions which will be most cost-effective;
• update the best buys from a diverse range of regional and national settings
and provide further guidance on total funding needed to implement them;
and
• work with Member States to collect and report in-country expenditure on
NCDs.

35
 NCD-GAP objective 3: To reduce modifiable risk factors for NCDs and
underlying social determinants through creation of health-promoting
environments
R3. WHO Secretariat and Member States to explore why progress seen in
relation to addressing tobacco use has not yet been seen in relation to other
risk factors.
WHO Secretariat to:
• explore why the progress seen in tobacco control is not being seen for other
risk factors;
• explore why policies on harmful use of alcohol are not associated with
implementation of identified cost-effective actions on harmful use of alcohol;
• explore what the barriers are to implementation of actions that are not
showing a positive association with income group in high-income country;
and
• review whether the range of cost-effective interventions for physical activity
can be expanded.

NCD-GAP objective 4: To strengthen and orient health systems to address

the prevention and control of NCDs and the underlying social determinants
through people-centred primary health care and universal health coverage
R4. WHO Secretariat and Member States to do more to ensure those affected
by NCDs are diagnosed, receiving treatment and having their condition
controlled.
WHO Secretariat:
• together with Member States, to identify practical ways in which responses
to NCDs can be better integrated into PHC and UHC;
• together with Member States, to improve monitoring of the number and
proportion of people receiving essential medicines in PHC, particularly to
reduce cardiovascular risk;
• together with Member States, international partners and non-state actors to
recognize and emphasize that it is important not to focus solely on a single
NCD; and
• to develop more concrete guidance on integrated NCD management in
primary care.

NCD-GAP objective 5: To promote and support national capacity for high-

quality research and development for the prevention and control of NCDs
R5. WHO Secretariat and Member States to determine how the priority of NCD
research can best be raised.
WHO Secretariat :
• and Member States to determine if lack of sufficient funding or an efficient
funding mechanism might be an underlying reason why little progress has
been made on NCD research and if so how this can be resolved;
• to develop a clear plan as to how it will support this area of work, including
identifying current research priorities and needs and how these will be
addressed;
• to identify respective roles and responsibilities for this objective, particularly
given the establishment of a Science Division; and
• to identify ways in which WHO collaborating centres can contribute to this
objective.

36
 NCD-GAP objective 6: To monitor the trends and determinants of NCDs and
evaluate progress in their prevention and control.
R6. WHO Secretariat and Member States to consider ways in which the
monitoring and surveillance of NCD responses can be further strengthened.
WHO Secretariat:
• and Member States to identify how to conduct risk factor surveys in a more
cost-effective and sustainable manner that builds local capacity and is
coherent with other national data systems;
• to ensure that future reporting to Member States on the AP indicator set
includes the indicator on research (AP5);
• to revise and update the AP indicator definitions and to clarify the baseline
year for progress reporting to the WHA, and then report on these to Member
States;
• to make data more readily available publicly and to use the available data
more, for example through in-house analysis in collaboration with partners;
• to brief Member States on what monitoring and reporting implications there
are of extending the NCD-GAP to 2030;
• Member States, international partners and non-State actors to develop
metrics for actors other than Member States, that is WHO, international
partners and non-state actors.
• and Member States to strengthen mechanisms for validation of country-
reported data, for example through civil society and in-county verification.
• and Member States to ensure that the final evaluation of NCD-GAP is able
to assess progress at the outcome level, as specified in the global monitoring
framework.

The NCD roadmap

The overarching goal of the NCD-GAP and SDG 3.4 is to reduce premature
mortality (33% by 2030) (52, 53, 54, 55). The rate of decline of the probability
of dying from cardiovascular disease, cancer, diabetes and chronic lung disease
between the ages of 30 and 70 years is “insufficient to meet Sustainable
Development Goal target 3.4” and at the current rate of progress, SDG target 3.4
would only be achieved by fewer than one-tenth of countries by 2030, most from
the high-income group (56, 57, 58). In many countries, the 2021/2022 COVID-19
pandemic is derailing the progress of NCD prevention and control (59).

An implementation roadmap 2023–2030 is being developed for the global action

plan for the prevention and control of noncommunicable diseases 2013–2030,
taking into consideration the recommendations of the mid-point evaluation of the
NCD-GAP 2013–2020. The implementation roadmap will focus on three strategic
directions: i) to understand the drivers and trajectories of the NCD burden across
countries and epidemiological regions; ii) to scale up the implementation of the
most impactful and feasible interventions in the national context; and iii) to ensure
timely and reliable data on NCD risk factors, diseases and mortality for informed
decision-making and accountability. The draft roadmap will be submitted through
the Executive Board at its 150th session, and through subsequent consultations
with Member States and relevant stakeholders, for consideration by the Seventy-
fifth WHA. 

37
 STAG-NCD
The challenge of reaching SDG target 3.4 on NCDs was already significant, even
before the COVID-19 pandemic emerged. Compounded by political polarization
and challenged multilateralism, the number of people and inequalities from
NCDs are growing. No country has yet been able to a) achieve the domestic
commitments made at the UNGA in 2011, 2014 and 2018; b) implement the
recommended actions for Member States made by the WHA in 2013 (60) and 2017
(61); c) implement the guidance provided by WHO through signature solutions
(62), special initiatives, investment cases and packages; and d) implement the
recommendations arising from the mid-point evaluation of the WHO NCD-GAP (63)
and the WHO High-level Commission on NCDs (64).

The STAG-NCD is invited to consider the following questions in its first meeting:

How could the WHO NCD programme be better adapted to the range of country
contexts in which it works in the COVID-19 pandemic and post-COVID-19 period,
framed through the settings of low-, lower-middle, upper-middle and high-
income countries, including through operationalization of the following mid-point
evaluation recommendations of the NCD-GAP:

• Get Member States to focus the limited financial resources available for NCDs
on the most cost-effective NCD interventions and to raise resources for scale-up,
considering the impact of COVID-19;

• Explore why progress seen in relation to addressing tobacco use has not yet
been seen in relation to other risk factors: harmful use of alcohol, unhealthy
diet and physical inactivity;

• Support Member States more to ensure that those affected by NCDs are
diagnosed and treated to improve health outcomes, using very cost-effective
and sustainable approaches; and support Member States to further strengthen
monitoring and surveillance of NCD responses.

How could WHO better exercise its leadership and coordination role in the
preparatory process towards the fourth High-level Meeting of the UNGA on the
Prevention and Control of NCDs in 2025, and the meeting itself, framed through:

• the status of the assignments given to WHO;

• the report of the UN Secretary-General and its recommendations (2024);

• the preparatory meetings, expected outcomes, and contributions; and

• the “asks” for the outcome document.

38
Annex references
(1) Strategic and Technical Advisory Group on the Prevention and Control of
Noncommunicable Diseases (STAG-NCD) [website] (https://www.who.int/
groups/strategic-and-technical-advisory-group-on-the-prevention-and-control-
of-noncommunicable-diseases-(stag-ncd)).
(2) In accordance with SDG targets 3.4 (NCDs and its risk factors), 3.5 (harmful
use of alcohol), 3.8 (UHC) and 3.a (tobacco control) of the 2030 Agenda for
Sustainable Development.
(3) In accordance with paragraph 24(a) of United Nations General Assembly
(UNGA). Resolution A/RES/74/2: Political declaration of the high-level meeting
on universal health coverage. New York: United Nations; 2019 (https://undocs.
org/en/A/RES/74/2).
(4) In accordance with paragraph 33 of United Nations General Assembly (UNGA).
Resolution A/RES/74/2: Political declaration of the high-level meeting on
universal health coverage. New York: United Nations; 2019 (https://undocs.
org/en/A/RES/74/2).
(5) UNGA. Resolution A/RES/66/2: Political declaration of the high-level meeting
of the General Assembly on the prevention and control of non-communicable
diseases. New York: United Nations; 2012
(https://www.un.org/en/ga/search/view_doc.asp?symbol=%20A/RES/66/2).
(6) UNGA. Resolution A/RES/68/300: Outcome document of the high-level
meeting of the General Assembly on the comprehensive review and
assessment of the progress achieved in the prevention and control of non-
communicable diseases. New York: United Nations; 2014 (https://research.
un.org/en/docs/ga/quick/).
(7) UNGA. Resolution A/73/L.2: Political declaration of the third high-level
meeting of the General Assembly on the prevention and control of non-
communicable diseases. New York: United Nations; 2018 (https://digitallibrary.
un.org/record/1645265?ln=en).
(8) World Health Assembly (WHA). WHA66 documents [website]; 2013
(https://apps.who.int/gb/e/e_wha66.html).
(9) UNGA. Resolution A/RES/74/2: Political declaration of the high-level meeting
on universal health coverage. New York: United Nations; 2019
(https://undocs.org/en/A/RES/74/2).
(10) Transforming our world: the 2030 Agenda for Sustainable Development.
New York: United Nations; 2015 (https://www.un.org/ga/search/viewm_doc.
asp?symbol=A/RES/70/1).
(11) Mid-point evaluation of the implementation of the WHO global action plan
for the prevention and control of noncommunicable diseases 2013–2020
(NCD-GAP). Geneva: WHO; 2020 (https://www.who.int/publications/m/item/
mid-point-evaluation-of-the-implementation-of-the-who-global-action-plan-
for-the-prevention-and-control-of-noncommunicable-diseases-2013-2020-
(ncd-gap)).
(12) Bennett, JE, Kontis, V, Mathers, CD, Guillot, M, Rehm, J, Guillot, M et al. NCD
countdown 2030: pathways to achieving Sustainable Development Goal target
3.4. Lancet; 2020;396:918-34
(https://doi.org/10.1016/S0140-6736(20)31761-X).

39
 (13) WHA. Resolution WHA66.10: Follow-up to the political declaration of the
high-level meeting of the General Assembly on the prevention and control of
noncommunicable diseases. Geneva: WHO; 2013
(https://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R10-en.pdf?ua=1).
(14) The sustainable development agenda [website]
(https://www.un.org/sustainabledevelopment/development-agenda-retired/).
(15) SDG indicators: metadata repository [database]
(https://unstats.un.org/sdgs/metadata?Text=&Goal=3&Target=3.4).
(16) Seventy-first World Health Assembly. Resolutions and decisions annex.
Document WHA71/2018/REC/1; 2018 (https://apps.who.int/gb/ebwha/pdf_files/
WHA71-REC1/A71_2018_REC1-en.pdf#page=1).
(17) Global action plan for the prevention and control of NCDs 2013-2020.
Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/
item/9789241506236).
(18) Tackling NCDs: “best buys” and other recommended interventions for the
prevention and control of noncommunicable diseases. Geneva: World Health
Organization; ‎2017
(https://apps.who.int/iris/handle/10665/259232).
(19) UNGA. Resolution A/RES/66/2, op. cit.
(20) Global action plan for the prevention and control of noncommunicable
diseases 2013–2020. Geneva: World Health Organization; 2013 (https://www.
who.int/publications/i/item/9789241506236).
(21) Global status report on noncommunicable diseases 2014. Geneva: World
Health Organization; 2014 (http://apps.who.int/iris/bitstream/hand
le/10665/148114/9789241564854_eng.pdf?sequence=1).
(22) United Nations Inter-Agency Task Force on NCDS (UNIATF) [website] (https://
www.who.int/groups/un-inter-agency-task-force-on-NCDs).
(23) Prevention and control of noncommunicable diseases. Terms of reference
for the global coordination mechanism on the prevention and control of
noncommunicable diseases. Report by the Director-General. Document A67/14
Add. 1. Provisional agenda item 13.1, Sixty-seventh World Health Assembly;
2014. Geneva: World Health Organization; 2014 (https://apps.who.int/gb/
ebwha/pdf_files/WHA67/A67_14Add1-en.pdf?ua=1).
(24) The Addis Ababa Action Agenda of the Third International Conference
on Financing for Development. New York: United Nations; 2016 (https://
sustainabledevelopment.un.org/content/documents/2051AAAA_Outcome.pdf).
(25) Time to deliver: report of the WHO independent high-level commission on
noncommunicable diseases. Geneva: World Health Organization; 2018 (https://
apps.who.int/iris/discover?query=high+level+commission+on+NCD).
(26) Declaration of Astana: Global Conference on Primary Health Care: Astana,
Kazakhstan, 25 and 26 October 2018. Geneva: World Health Organization;
2019 (https://apps.who.int/iris/handle/10665/328123).
(27) Seventy-second World Health Assembly. Resolutions and decisions annexes.
Geneva: World Health Organization; 2019 (https://apps.who.int/gb/ebwha/
pdf_files/WHA72-REC1/A72_2019_REC1-en.pdf#page=68).
(28) Noncommunicable diseases progress monitor 2020. Geneva: World Health
Organization; 2020 (https://www.who.int/publications/i/item/ncd-progress-
monitor-2020).

40
(29) Thirteenth General Programme of Work 2019–2023 [website] (https://
www.who.int/about/what-we-do/thirteenth-general-programme-of-
work-2019---2023).
(30) Mid-point evaluation of the implementation of the WHO global action plan,
op cit.
(31) World health statistics 2021. A visual summary [website] (https://www.who.int/
data/stories/world-health-statistics-2021-a-visual-summary).
(32) The top 10 causes of death. 9 December 2020 [website] (https://www.who.int/
news-room/fact-sheets/detail/the-top-10-causes-of-death).
(33) World health statistics 2021. A visual summary [website], op cit.
(34) World health statistics 2021. Monitoring health for the SDGs. Geneva:
World Health Organization; 2021 (https://apps.who.int/iris/bitstream/hand
le/10665/342703/9789240027053-eng.pdf).
(35) World health statistics 2021. A visual summary [website], op cit.
(36) The global health observatory. SDG Target 3.4 Non-communicable diseases
and mental health [website] (https://www.who.int/data/gho/data/themes/
topics/sdg-target-3_4-noncommunicable-diseases-and-mental-health).
(37) World health statistics 2020. Monitoring health for the SDGs. Geneva:
World Health Organization; 2020 (https://apps.who.int/iris/bitstream/hand
le/10665/332070/9789240005105-eng.pdf).
(38) The global health observatory. SDG Target 3.4, op cit.
(39) World health statistics 2020. A visual summary [website]
(https://www.who.int/data/gho/whs-2020-visual-summary).
(40) World health statistics 2021. Monitoring health for the SDGs, op cit.
(41) World health statistics 2020. Monitoring health for the SDGs, op cit.
(42) Ibid.
(43) Rapid assessment of service delivery for NCDs during the COVID-19
pandemic. Geneva: World Health Organization; 2020 (https://www.who.int/
publications/m/item/rapid-assessment-of-service-delivery-for-ncds-during-the-
covid-19-pandemic).
(44) Mid-point evaluation of the implementation of the WHO global action plan,
op cit.
(45) Global Burden of Disease Health Financing Collaborator Network. Past,
present, and future of global health financing: a review of development
assistance, government, out-of-pocket, and other private spending on health
for 195 countries, 1995-2050. Lancet; 2019:2233-60
(https://pubmed.ncbi.nlm.nih.gov/31030984/).
(46) Assessing national capacity for the prevention and control of
noncommunicable diseases: report of the 2019 global survey. Geneva: World
Health Organization; 2020 (https://www.who.int/publications/i/item/ncd-
ccs-2019).
(47) Global Observatory on Health Research and Development. Health researchers
(in full-time equivalent) per million inhabitants, by income group (second set
of charts) [database] (https://www.who.int/observatories/global-observatory-
on-health-research-and-development/indicators/health-researchers-in-full-
time-equivalent-per-million-inhabitants-by-income-group-second-set-of-
charts).

41
 (48) Noncommunicable diseases progress monitor 2020. Geneva: World Health
Organization; 2020 (https://www.who.int/publications/i/item/ncd-progress-
monitor-2020).
(49) Assessing national capacity for the prevention and control of
noncommunicable diseases: report of the 2019 global survey. Geneva: World
Health Organization; 2020 (https://www.who.int/publications/i/item/ncd-
ccs-2019).
(50) STEPwise Approach to NCD Risk Factor Surveillance (STEPS) [website]
(https://www.who.int/ncds/surveillance/steps/en/).
(51) Mid-point evaluation of the implementation of the WHO global action plan,
op cit.
(52) Political declaration of the third high-level meeting of the General Assembly
on the prevention and control of non-communicable diseases. Report by the
Director-General. Document EB148/7. World Health Organization;13 January
2021
(https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_7-en.pdf).
(53) Follow-up to the high-level meeting of the United Nations General Assembly
on health-related issues. Political declaration of the third high-level meeting
of the General Assembly on the prevention and control of non-communicable
diseases. Report by the Director-General. Document EB146/7. World Health
Organization; 11 December 2019 (https://apps.who.int/gb/ebwha/pdf_files/
EB146/B146_7-en.pdf).
(54) Follow-up to the high-level meeting of the United Nations General Assembly
on health-related issues. Prevention and control of noncommunicable
diseases. Report by the Director-General. Document A72/19. World Health
Organization; 18 April 2019 (https://apps.who.int/gb/ebwha/pdf_files/WHA72/
A72_19-en.pdf).
(55) Preparation for the third high-level meeting of the General Assembly on
the prevention and control of non-communicable diseases, to be held in
2018. Report by the Director-General. Document A71/14. World Health
Organization; 19 April 2018 (https://apps.who.int/gb/ebwha/pdf_files/WHA71/
A71_14-en.pdf).
(56) Progress on the prevention and control of non-communicable diseases.
Report of the Secretary-General (fourth report). Document A/72/662. United
Nations; 21 December 2017 (https://undocs.org/en/A/72/662).
(57) Note by the Secretary-General transmitting the report of the Director-General
of the World Health Organization on the prevention and control of non-
communicable diseases (third report). Document A/68/650; 10 December 2013
(https://undocs.org/A/68/650).
(58) Prevention and control of non-communicable diseases. Report of the
Secretary-General (second report). Document A/66/83; 19 May 2011
(https://undocs.org/en/A/66/83).
(59) Preparation for the third high-level meeting of the General Assembly; 2018,
op cit.
(60) WHA66. Documents [website] (https://apps.who.int/gb/e/e_wha66.html).
(61) Tackling NCDS: “best buys” and other recommended interventions for the
prevention and control of noncommunicable diseases. Geneva: World Health
Organization; 2017 (https://apps.who.int/iris/handle/10665/259232).

42
(62) Noncommunicable diseases: about us [website]
(https://www.who.int/teams/noncommunicable-diseases/about).
(63) Mid-point evaluation of the implementation of the WHO global action plan,
op cit.
(64) Time to deliver: report of the WHO independent high-level commission on
noncommunicable diseases. Geneva: World Health Organization; 2018
(https://apps.who.int/iris/discover?query=high+level+commission+on+NCD).

43